Zika Virus Emergency Preparedness

Page 1

Zika Virus Emergency Preparedness:

Guidelines for Pregnant woman with possible exposure to the
virus.

By: Tara Pospeschil

For: Michele ODonnell
Mental Health Nursing
Spring 2016

Zika Virus Emergency Preparedness

Page 2
According to the CDC, In May 2015 the Pan American Health
Organization (PAHO) issued an alert regarding the first confirmed Zika virus
infection in Brazil and on Feb 1, 2016, the World Health Organization (WHO)
declared Zika virus a public health emergency of international concern
(PHEIC). The Zika virus is spread through a bite from the Aedes mosquito or
sexually transmitted from an infected person. Zika Virus usually stays in the
blood for about 1 week, but can be longer. The virus can stay in semen
longer than blood and the virus can be spread when the man has symptoms,
before symptoms start, and after symptoms end. Symptoms are usually mild,
so many people do not realize that they are infected. Also, once someone
has become infected, they are likely to be protected from future infections.
The mild symptoms include fever, rash, joint pain, and conjunctivitis. These
symptoms usually last days to a week.
In 1952, the first case of Zika virus in humans was found and since
then outbreaks have been reported in tropical Africa, Southeast Asia, and the
Pacific Islands. Before 2007, about 14 cases have been reported, but many
cases are unrecognized because the symptoms are similar to those of other
diseases. The virus has made its way to the United States, Illinois has 3
cases, Minnesota has 3 cases, but Wisconsin doesnt have any. This does not
mean that Wisconsin cannot see cases in the future, it just means as of now,
there are no reported cases.

Zika Virus Emergency Preparedness

Page 3
The danger with the Zika virus, is that the virus can be spread from a
pregnant woman to her fetus. Since May 2015, Brazil has seen an increased
incidence of the Zika virus as well as an increased incidence of Microcephaly
in newborns. Researchers are working to study if there is a link between the
two, but for now it cannot be confirmed for sure whether or not the
Microcephaly is caused by the Zika virus. Microcephaly is a birth defect
where the babys head is smaller than expected compared to babies of the
same age and sex. In these cases, the babys brains might not have
developed properly and in extreme cases can cause developmental delays,
movement problems, intellectual disabilities and feeding problems. These
problems can range from mild to severe and are often lifelong. State birth
defects tracking systems state that microcephaly is seen in about 12 babies
per 10,000 births in the U.S. Based on current evidence, the CDC believes
that Zika virus infection in a woman who is not pregnant would not pose a
risk for birth defects in future pregnancies after the virus is cleared from her
blood. Also, that once a person is infected with Zika virus it is likely he or she
is protected from a future Zika infection.
Preventing Zika virus here in the United States, begins with advising
pregnant women not to travel to counties/areas of infection. If people live in
a state or area with the mosquito that spreads the virus then they should
have a prevention kit. This would include: a bed net, insect repellent,
permethrin spray, standing water treatment tabs, a thermometer, and
condoms. This is particularly important to prevent the spread to woman who

Zika Virus Emergency Preparedness

Page 4
are pregnant. Couples who have been diagnosed with Zika virus should
consider using condoms or not have sex for at least 6 months after
symptoms begin. Couples who have traveled to an area with Zika virus, but
did not develop symptoms should consider using a condom for a least 8
weeks after return. Couples who live in an area with Zika virus, but have not
developed symptoms should consider using condoms or not having sex while
the virus is in the area.
Treatment available currently is to manage the symptoms. This
includes getting plenty of rest, drinking fluids, and taking Tylenol to reduce
fever and pain. It is recommended that people do not take NSAIDS until
dengue can ruled out to reduce the risk of bleeding. Currently there is no
vaccine available or medicine to treat the Zika virus. If a person has the
virus, they should prevent mosquito bites during the first week of their
illness. The virus can be found in blood and passed from an infected person
to a mosquito through mosquito bites.
Currently the federal, state, and local emergency response systems are
working towards prevention and treatment of the Zika Virus in pregnant
women. At the federal government level, they are working with international
public health partners and state health departments: to alert the public and
providers about Zika, post travel notices and guidance, provide health labs
with diagnostic tests, detect and report cases and support mosquito control
programs in the United States and around the world. Furthermore, the

Zika Virus Emergency Preparedness

Page 5
federal government is currently investigating the association between Zika
and microcephaly as well as Zika and Guillain-Barre syndrome. At the state
and local health public agencies, they are working with the CDCs arbovirus
diagnostic lab to test for Zika virus. They are also reporting laboratoryconfirmed cases of Zika to the CDC through arboNET which is the national
surveillance system for arboviral disease. Additionally, they activate or
enhance mosquito surveillance and control response to local cases of Zika. At
the local level, health care providers are also involved in prevention and
treatment of the virus. Providers screen their patients for travel history as
well as symptoms such as fever, rash, joint pain, and conjunctivitis. They
contact the state and local health department for diagnostic lab testing and
offer serologic testing to asymptomatic pregnant women between 2 and 12
weeks after return from travel to areas with ongoing Zika outbreak.
Locally in Wisconsin, the department of health services is working with
the CDC to diagnose and test potential infected patients. There is currently
no test for Zika virus, but the virus symptoms are similar to dengue and
chikungunya, so blood tests may be ordered for all three. Testing includes a
Zika virus IgM serology and confirmatory testing if positive. These tests are
done locally at the Wisconsin State Laboratory of Hygiene. In order to be
tested at the local level, patients must meet the following criteria: history of
travel to infected areas within 2 weeks from onset of illness and present at
least two of the symptoms of the virus. Testing for pregnant woman is done if
they have traveled to an infected area and got pregnant within 2 to 12

Zika Virus Emergency Preparedness

Page 6
weeks after travel. In Wisconsin, there is currently no specific antiviral
treatment available. Treatment is supportive and includes rest, fluids, and
supportive care. They are recommending to avoid use of Aspirin and NSAIDS
until dengue is ruled out to reduce the risk of hemorrhage. It is recommend
that pregnant women be treated with acetaminophen if necessary.
Prevention is a huge concern in Wisconsin with the summer season
approaching. It is recommended that people avoid exposure to mosquitos by
using air conditioning, window/door screens, wear long sleeves and pants,
and use EPA registered repellants when outside. Pregnant women are
recommended not to travel to areas infected with Zika. Additionally, it is
recommended that people who are already infected with Zika protect
themselves from exposure to mosquitos during their illness to prevent local
transmission of the virus. The health department is also working locally with
UW-Madison to support mosquito surveillance for possible emerging Aedes
species and reporting confirmed and/or probable cases to the CDC arboNET.
In Wausau Wisconsin, there is a local health department located at
1000 Lake View Drive, Suite 100 Wausau, WI 54403. People can be directed
to this facility for testing of the virus and any questions pertaining to the Zika
virus. They also have a phone number which is 715-261-1900. They are open
Monday-Friday from 8am 4:30pm. People are also encouraged to see their
own health providers and go to a local clinic with questions or concerns
about the virus. Another important resource available to residents in Wausau
Wisconsin is the Bridge Community Health Clinic. This is a free clinic that

Zika Virus Emergency Preparedness

Page 7
people can go to if they do not have insurance and they can provide answers
to patients with questions about the virus. This clinic is located at 1810 N.
Second Street Wausau, WI 54403 and their phone number is 715-848-4884.
Overall, there are many resources available to the public and as nurses it is
our job to increase awareness of not only the disease itself, but resources for
patients to use.

References

Zika Virus Emergency Preparedness

Page 8
Centers for Disease Control and Prevention. (2016). CDCs Response to Zika
What can be done. http://www.cdc.gov/zika/pdfs/zikawhatcanbedone.pdf
Centers for Disease Control and Prevention. (2016). About Zika Disease.
http://www.cdc.gov/zika/about/index.html
Centers for Disease Control and Prevention. (2016). Prevention.
http://www.cdc.gov/zika/prevention/index.html
Centers for Disease Control and Prevention. (2016). Transmission & Risks.
http://www.cdc.gov/zika/transmission/index.html
Centers for Disease Control and Prevention. (2016). Symptoms, Diagnosis &
Treatment. http://www.cdc.gov/zika/symptoms/index.html
Centers for Disease Control and Prevention. (2016). Areas with Zika.
http://www.cdc.gov/zika/geo/index.html
Centers for Disease Control and Prevention. (2016). Zika and Pregnancy.
http://www.cdc.gov/zika/pregnancy/question-answers.html
Centers for Disease Control and Prevention. (2016). How to Protect Yourself.
http://www.cdc.gov/zika/pregnancy/protect-yourself.html
Wisconsin Department of Health Services. (2016). Zika Virus Infection
Update, Wisconsin, 2016.
https://www.dhs.wisconsin.gov/arboviral/zikaupdate1.pdf
Wisconsin Department of Health Services. (2016). Wisconsin Local Health
Departments Marathon County. https://www.dhs.wisconsin.gov/lhdepts/counties/marathon.htm
Bridge Community Health Clinic. (2013). Hours and Sites.
http://www.bridgeclinic.org/index.cfm?pid=4&pageTitle=Hours-andSites